Association of cardiovascular risk factors with diabetic kidney disease severity in the Iranian population

Abstract Diabetic Kidney Disease (DKD), a serious complication of diabetes mellitus, is a leading cause of end-stage renal disease and a significantly contributes to cardiovascular morbidity. This study investigated the association of cardiovascular disease (CVD) risk factors with the severity of DKD in the Iranian population. Utilizing data from the 2021 nationwide STEPwise approach to Noncommunicable Disease Risk Factor Surveillance, this cross-sectional analysis included 3272 diabetic adults aged ≥ 25 years. DKD was defined based on estimated glomerular filtration rate (eGFR) and albuminuria levels using the KDIGO guideline. Key CVD risk factors were examined through multivariable ordinal logistic regression analysis. Among the participants, 7.64% (95% CI 6.73,8.55) and 20.3% (95% CI 18.92,21.68) were classified as having high/very high and moderately DKD risk, respectively. Older age [adjusted odds ratio (AOR) = 1.81, 95% CI 1.19,2.73], longer diabetes duration (≥ 10 years) (AOR = 1.33, 95% CI 1.07,1.64), ever smoking (AOR = 1.31, 95% CI 1.07,1.60), systolic blood pressure (SBP) ≥ 140 mmHg (AOR = 1.42, 95% CI 1.17,1.73), uncontrolled glycemic status (HbA1c ≥ 7) (AOR = 1.57, 95% CI: 1.32,1.88), dyslipidemia (AOR = 1.53, 955 CI 1.12,2.07), use of insulin (AOR = 2.45, 95% CI 1.59,3.75) and multiple antihypertensive medications (AOR = 2.15, 95% CI 1.63,2.85) were significantly associated with higher DKD severity. Conversely, higher education (≥ 12 years) (AOR: 0.74, 95% CI 0.59,0.92, p = 0.007) was associated with lower DKD severity. CVD risk factors, particularly hypertension, dyslipidemia, and poor glycemic control, exhibited strong associations with the severity of DKD. These findings underscore the importance of early risk stratification and the implementation of targeted interventions to delay renal deterioration among patients with diabetes.